Provider Demographics
NPI:1679081939
Name:RODRIGUEZ CAMEJO, ISRAEL
Entity type:Individual
Prefix:
First Name:ISRAEL
Middle Name:
Last Name:RODRIGUEZ CAMEJO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 MCLEOD DR APT 189
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-2248
Mailing Address - Country:US
Mailing Address - Phone:702-517-1447
Mailing Address - Fax:
Practice Address - Street 1:3200 MCLEOD DR APT 189
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-2248
Practice Address - Country:US
Practice Address - Phone:702-517-1447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-19
Last Update Date:2018-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No372600000XNursing Service Related ProvidersAdult Companion
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2104399131OtherDRIVERS LICENSE